Manager - Credentialing

US-TX-Dallas
Job ID
2017-1398
Function
Revenue Cycle Management
Employment Status
Full-Time

Overview

This position is a customer service oriented position that will direct the daily activities of a high volume Credentialing department. Provides direct interaction with Hospital Medical Staff Services and other departments requiring specific provider related information. In addition this position will maintain positive relationships with our providers and facilities, ensuring that information is provided timely and problem resolution is a seamless process. This position will ensure the integrity of all information provided to facilities and or Government agencies while maintaining the utmost confidentiality.

Responsibilities

CREDENTIALING:

  • Direct the daily activities of the credentialing department.
  • Responsible for monitoring staff productivity and work quality.
  • Ensure timely and accurate submission of all data to facilities, government agencies and Managed Care Plans.
  • Review and present files to the QI Committee on a monthly basis for new credentialing or re-credentialing evaluations.
  • Participate in the yearly malpractice insurance renewal process working closely with the CFO, Quality Management and Risk Management department heads.
  • Ensure that any issues regarding state medical license, Federal Drug Enforcement Administration (DEA), or other pertinent agency data are resolved timely and with the utmost confidentiality.
  • Maintain information regarding Continuing Education Opportunities for Providers and oversee data base retention of all Continuing Medical Education (CME) data.
  • Work closely with Physician Recruiter and Human resources to maintain accurate physician headcount and status of all recruits.
  • Ensure all departmental policies and procedures are documented, maintained and followed on an on-going basis.
  • Maintain customer contacts with all levels of personnel, including physicians, division manager’s executive committee, USAP Senior Management Team and a multitude of external contacts at all levels.
  • Foster and encourage a positive work environment and maintain thorough staff retention or recruitment experiences for Credentialing and Provider Enrollment staff.
  • Maintain Departmental budget at or below the yearly projections.
  • Maintain data management and work processes in Credentialing Software application. Experience with Morrisey (Apogee) or similar credentialing applications is preferred.
  • Performs other duties as assigned.

 

MANAGED CARE:

  • Ensure the timely and accurate submission of all Managed Care applications.
  • Oversee the maintenance of the Managed Care Grid and all related reports.
  • Act as a liaison between the Central Business Office and managed care entities to ensure the timely review of applications for effective dates.
  • Maintain the managed care files and contract histories.
  • Oversee all new provider managed care projects.

Qualifications

  • Bachelor’s degree in business, healthcare administration or relevant field and three to five years of solid Healthcare management experience; or equivalent combination of education and experience.
  • Professional Certification is preferred
  • Three to Five years of direct Physician interaction.
  • Five years of Supervisory/Management experience working

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